/ PEACE RIVER REGIONAL DISTRICT
Recreation and Cultural Grants-in-Aid
Schedule “B” - Claim Form

Organization Name: Click here to enter text.Date: Click here to enter text.

Mailing Address:Click here to enter text.Click here to enter text.Click here to enter text. Address City Postal Code

Contact Person: Click here to enter text.Phone Number: Click here to enter text.

Please attach COPIES ONLY of invoices you are claiming reimbursement for. LIST ALL INVOICES BELOW and include the name of the supplier, the project they are for (i.e., playground, fence, insurance, etc.), year the fund were provided, invoice number and amount. If you have any questions about your claim please call (250) 784-3200.

Supplier / Project / Year Funds Granted for this Project / Invoice No. / $ Amount
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Total Amount of Invoice / Click here to enter text. /
Amount You Are Claiming / Click here to enter text. /

Please deliver your claim via mail, in person or by fax to: Peace River Regional District

PO Box 810, 1981 Alaska Avenue

Dawson Creek, BC V1G 4H8

Fax: (250) 784-3201

For Office Use Only

Coding / Year / Amount
Approved
Total Claim
YEAR / YEAR
Grant Amount / Grant Amount
Previous Claims from this Grant / Previous Claims from this Grant
Current Claim / Current Claim
Balance on this Grant / Balance on this Grant

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